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Titolo:
Percutaneous tracheostomy in critically ill patients: A prospective, randomized comparison of two techniques
Autore:
Nates, JL; Cooper, J; Myles, PS; Scheinkestel, CD; Tuxen, DV;
Indirizzi:
Alfred Hosp, Dept Intens Care & Hyperbar Med, Melbourne, Vic 3181, Australia Alfred Hosp Melbourne Vic Australia 3181 , Melbourne, Vic 3181, Australia Alfred Hosp, Dept Anesthesia, Melbourne, Vic 3181, Australia Alfred Hosp Melbourne Vic Australia 3181 , Melbourne, Vic 3181, Australia
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 11, volume: 28, anno: 2000,
pagine: 3734 - 3739
SICI:
0090-3493(200011)28:11<3734:PTICIP>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
EVALUATING 2 SYSTEMS; INTENSIVE-CARE UNIT; DILATIONAL TRACHEOSTOMY; DILATATIONAL TRACHEOSTOMY; BEDSIDE PROCEDURE; EXPERIENCE; MANAGEMENT; TRIAL;
Keywords:
tracheostomy; percutaneous; dilational; prospective; randomized; complications; equipment design; airway obstruction; hemorrhage; anesthesia;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Nates, JL Univ Texas, Hlth Sci Ctr, Dept Neurosurg, Sch Med, 6410 Fannin,HPB 1020, Houston, TX 77030 USA Univ Texas 6410 Fannin,HPB 1020 Houston TX USA 77030 X 77030 USA
Citazione:
J.L. Nates et al., "Percutaneous tracheostomy in critically ill patients: A prospective, randomized comparison of two techniques", CRIT CARE M, 28(11), 2000, pp. 3734-3739

Abstract

Objective: To prospectively compare two commonly used methods for percutaneous dilational tracheostomy (PDT) in critically ill patients. Design: Prospective, randomized, clinical trial. Setting: Trauma and general intensive care units of a university tertiary teaching hospital, which is also a level 1 trauma center. Patients: One hundred critically ill patients with an indication for PDT. Interventions: PDT with the Ciaglia technique using the Ciaglia PDT introducer set and the Griggs technique using a Griggs PDT kit and guidewire dilating forceps. Measurements and Main Results: Surgical time, difficulties, and surgical and anesthesia complications were measured at 0-2 hrs, 24 hrs, and 7 days postprocedure. Groups were well matched, and there were no differences between the two methods in surgical time or in anesthesia complications. Major bleeding complications were 4.4 times more frequent with the Griggs PDT kit. With the Ciaglia PDT kit, both intraoperative and at 2 and 24 hrs, surgicalcomplications were less common (p = .023) and the procedure was more oftencompleted without expert assistance (p = .013). Tracheostomy bleeding was not associated with either anticoagulant therapy or an abnormal clotting profile. Multivariate analysis identified the predictors of PDT complicationsas the Griggs PDT kit (p = .027) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = .041). The significant predictors of time required to complete PDT were the APACHE II score (p = .041), a less experienced operator (p = .0001), and a female patient (p = .013). Conclusions: Patients experiencing PDT with the Ciaglia PDT kit had a lower surgical complication rate (2% vs. 25%), less operative and postoperativebleeding, and less overall technical difficulties than did patients undergoing PDT with the Griggs PDT kit Ciaglia PDT is, therefore, the preferred technique for percutaneous tracheostomy in critically ill patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 27/09/20 alle ore 13:41:34